Mnemonic

Urine Concentrating and Diluting Ability

A memory aid for the range of urine osmolality and what is required for each extreme.

Expansion

From 50 to 1200 mOsm per kilogram, needing an intact loop, gradient and hormone

Expansion

Urine osmolality ranges from about 50 to 1200 mOsm/kg.

To concentrate urine you need

  • A functioning loop of Henle to build the gradient
  • An intact medullary gradient, preserved by low vasa recta flow
  • Antidiuretic hormone
  • Responsive collecting ducts with aquaporin-2

Failure of any one causes polyuria: loop diuretics abolish the gradient, central diabetes insipidus removes the hormone, and lithium or hypercalcaemia cause nephrogenic resistance.

To dilute urine you need a functioning ascending limb (which removes solute without water) and the absence of antidiuretic hormone.

Obligatory urine volume: the daily solute load is about 600 mOsm, so at a maximum concentration of 1200 mOsm/kg the minimum urine volume is 500 ml. A low solute intake, as in “beer potomania” or a tea and toast diet, reduces the solute load and therefore the capacity to excrete water, which is why these states cause hyponatraemia.